Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients

Winkel, Tamara A.; Schouten, Olaf; Hoeks, Sanne E.; Flu, Willem-Jan; Hampton, Dave; Kirchhof, Paulus; Kuijk, Jan-Peter van; Lindemans, Jan; Verhagen, Hence J.M.; Bax, Jeroen J.; Poldermans, Don

doi:10.1016/j.ahj.2010.03.035

Cited by 12 publications

(16 citation statements)

References 27 publications

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“…In the perioperative context physicians have to distinguish between pre-existing atrial fi brillation (prevalence of 8% in patients >80 years) and new-onset atrial fi brillation which is one of the most common arrhythmias after surgery occurring in 4% of the patients undergoing vascular surgery [88]. Th e incidence of arrhythmias varies from 4-20% in patients undergoing non-cardiac surgery up to 63% after cardiac valvular surgery.…”

Section: Pathophysiologymentioning

confidence: 99%

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Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

Böck

Wiedermann

Motsch

et al. 2011

Wien Klin Wochenschr

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All the concepts described require an interdisciplinary approach in collaboration between operative physicians and physicians working in non-surgical disciplines like internal medicine, cardiology, and clinical pharmacology. The perioperative continuation of a pre-existing therapy with beta-blockers and other potentially cardioprotective agents like α(2)-agonists and statines is recommended. In the management of patients presenting for major surgery stratification of the perioperative risk is essential which considers both, invasiveness of the surgical procedure and conditions of the patient. Otherwise, side-effects might outweigh benefits of a potentially effective therapy as recently shown for the perioperative administration of beta-blockers that should be restricted to high-risk patients.

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Section: Pathophysiologymentioning

confidence: 99%

“…New-onset cardiac arrhythmias are often transient (98% conversion rate of atrial fi brillation within two months after thoracic surgery), but they may also be associated with long-term cardiovascular events, stroke, mortality after cardiac [90] and even non-cardiac surgery [88].…”

Section: Recent Evidencementioning

confidence: 99%

Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

Böck

Wiedermann

Motsch

et al. 2011

Wien Klin Wochenschr

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“…Perioperative ischemia and infarction have shown to be risk factors for increased cardiac mortality in the perioperative period as well as in long-term follow-up. This has also been described for HF and arrhythmias [16,17]. Based on the pharmacological properties of b-blockers, they could play a prominent role in the treatment and prevention of these risk factors.…”

mentioning

confidence: 97%

Safety of perioperative β-blocker use: how do β-blockers compare in terms of side effects?

Ravensbergen

Voûte

Poldermans

2011

Expert Opinion on Drug Safety

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“…4,5 Using 72-hour Holter recordings, we observed an incidence of perioperative arrhythmias of 11%, 21% of which were recorded after troponin release. 4 With an ILR, the true incidence might prove to be even higher.In addition, the settings of the ILR are of importance. In CARISMA, a ventricular tachycardia would only be identified if every beat was at a rate of 125 beats per minute, with a minimal length of 16 beats.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Letter by Ravensbergen et al Regarding Article, “Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction: The Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) Study”

Ravensbergen¹,

Verhagen

Melis

2012

Circulation

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Patients who suffer a myocardial infarction (MI) are at risk of late sudden cardiac death. The underlying cause can be divided into 2 groups: recurrent acute MI or cardiac rupture, and arrhythmias. 1 The second group might benefit from an implantable cardioverterdefibrillator, but identification of those patients who will benefit the most remains a continuous challenge.Recently, the 2-year follow-up of the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) trial was published in Circulation and commented on by Buxton. 2 The study showed that, among 297 patients with a left ventricular ejection fraction Յ40% after an acute MI, a high-degree atrioventricular (AV) block was the most powerful predictor of cardiac death, and secondarily, the heart rate variability analysis in the longer period (after 6 weeks), as shown by previously published results.The CARISMA investigators also conclude that the incidence of clinically relevant arrhythmias might have been underestimated because of limitations of the implantable loop recorder (ILR).The main messages we take from CARISMA is that we underestimate the incidence/clinical relevance of atrial and ventricular arrhythmias, and that continuous monitoring, in selected patients, may be a valuable choice if improved and adjusted.Recently, Scirica et al 3 showed that short runs of nonsustained ventricular tachycardia (Ն4 beats) still existing 48 hours after MI were associated with a higher risk of sudden cardiac death. It was not possible to identify these early arrhythmias in the CARISMA Study due to 2 factors: time of implantation and settings of the ILR. Because post-MI patients are identified by having an event, the ILR will always be implanted after the event has taken place (in CARISMA, mean of 11 days after MI), and may miss the early detection window.We would like to offer a complementary approach for a better understanding: different populations with a high risk of cardiac complications that might provide a solution for capturing these critical nonsustained ventricular tachycardia. We experienced a high incidence of new-onset arrhythmias and MI in elective vascular surgery patients. 4,5 Using 72-hour Holter recordings, we observed an incidence of perioperative arrhythmias of 11%, 21% of which were recorded after troponin release. 4 With an ILR, the true incidence might prove to be even higher.In addition, the settings of the ILR are of importance. In CARISMA, a ventricular tachycardia would only be identified if every beat was at a rate of 125 beats per minute, with a minimal length of 16 beats. In order to detect all clinically relevant arrhythmias, the settings need to have a higher specificity and programmability, which are now available in newer generations of ILR.To further improve identification of patients at risk of sudden cardiac death directly post-MI, the ILR can be combined with a Holter recording. In this way, heart rate variability and presence of nonsustained ventricular tachycardia, which are predictors of later arrh...

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Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients

Cited by 12 publications

References 27 publications

Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

Safety of perioperative β-blocker use: how do β-blockers compare in terms of side effects?

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